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Abstract Details

“Early Mobilization Protocol” Can Be Initiated in the Intensive Care Unit in Acute Ischemic Stroke Patients After Receiving Intravenous Alteplase
Cerebrovascular Disease and Interventional Neurology
P9 - Poster Session 9 (5:30 PM-6:30 PM)
Current guidelines recommend bed rest for 24 hours after receiving intravenous alteplase which may not be necessary and delay rehabilitation in a large proportion of acute ischemic stroke patients. 

To determine the feasibility of “early mobilization protocol” within the intensive care unit (ICU) in patients with acute ischemic stroke who received intravenous alteplase.

All consecutive patients were admitted to the ICU with an acute ischemic stroke who received intravenous alteplase from October 2019-June 2021 were considered for “early mobilization protocol”. Patients≥18 years of age with NIHSS score ≤22 were eligible and mobilization was initiated within 13-24 hours after intravenous alteplase administration. Eligibility criteria included HR < 100 bpm and BP < 180/105 mm Hg or SBP > 90 mm.  Exclusion criteria included hemodynamic instability, unstable neurological examination or progressive symptoms, presence of external ventricular drain for hemorrhagic transformation within 24 hours of intravenous alteplase.
A total of 137 patients (56.8%) patients were eligible among 241 patients who were admitted to our institution with acute ischemic stroke after receiving intravenous alteplase. Mean age (±SD) was 63.4±16.6 and 66.2±17.0 years for the patients included and excluded in the early mobilization protocol, respectively. The mean NIHSS score (±SD) at baseline was 5.3±4.4 and 9.9±7.3 for the patients included and excluded respectively. Early mobilization protocol was initiated at 18.3±3.6 hours in eligible patients compared with 41.6±19.8 hours in excluded patients (p<0.001). The mean NIHSS score (±SD) at discharge (1.0±2.2 versus 4.2±7.0, p<0.001) was significantly lower and rate of modified Rankin scale 0-1 at discharge (86.9% versus 67.3%, p=0.0003) was significantly higher in patients in the early mobilization protocol compared with those who were excluded. 

Early mobilization protocol in patients post intravenous alteplase treatment can be initiated in the ICU in appropriately selected patients without any adverse effects on neurological and functional outcomes.

Sachin M. Bhagavan, MD (University of Missouri- Health Care)
Dr. Bhagavan has nothing to disclose.
Muhammad Fawad Ishfaq, MD Dr. Ishfaq has nothing to disclose.
Shruthi HR Pulimamidi Dr. Pulimamidi has nothing to disclose.
Megan Sweeney, Other Ms. Sweeney has nothing to disclose.
Anudeep yelam, MD Dr. yelam has nothing to disclose.
Eric T. Lybeck-Brown, PT Dr. Lybeck-Brown has nothing to disclose.
Wei Huang Wei Huang has nothing to disclose.
Attiya Jaura, Other Ms. Jaura has nothing to disclose.
Swathi Beladakere Ramaswamy, MD (University of Missouri Healthcare, Dept of Neurology) Dr. Beladakere Ramaswamy has nothing to disclose.
Nakul Katyal, MD (University of Kentucky ) Dr. Katyal has nothing to disclose.
Kunal Bhatia, MD (University of Mississippi Medical Center) Dr. Bhatia has nothing to disclose.
Brandi R. French, MD (University of Missouri) Dr. French has nothing to disclose.
Camilo Ramiro Gomez, MD, FAAN (University of Missouri) Dr. Gomez has nothing to disclose.
Adnan I. Qureshi, MD (Dept of Neurology) Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.